Caring for the next Miriam Carey

Rada K. Dagher

Miriam Carey, a 34 year-old dental hygienist, created a media frenzy last week when she was shot and killed by Capitol police after ramming a White House barricade in her car while her one-year-old daughter was in the back seat. Why did she do it? What mental illness did she suffer from?

Ms. Carey's mother said her daughter was diagnosed with postpartum depression after her baby was born, and months later she was hospitalized for feeling sick and depressed. Some media outlets took that to mean that postpartum depression was behind Ms. Carey's erratic behavior. These assumptions threaten to stigmatize women who experience postpartum depression — about half a million women in the U.S. annually — and dissuade them from getting needed mental health care, when this disorder is already under-diagnosed.

Moreover, some news media highlighted the fact that Ms. Carey was African American and that African American women have higher postpartum depression rates than white women. While it is true that some studies suggest that, other studies show no such racial differences. More importantly, studies show that socioeconomic differences account for racial differences in postpartum depression. Ms. Carey was a single mother who was fired from her job while pregnant and had been sued by her condominium association for failure to pay fees. Lack of social support, the stress of being fired, and financial troubles are the more likely explanations of Ms. Carey's deteriorating mental health than her race.

While postpartum depression is characterized by symptoms such as diminished interest, fear and guilt, insomnia, and in extreme cases suicidal thoughts, it does not usually result in endangering a woman's life or her child's, or in delirious thoughts such as Ms. Carey's reported belief she was the "Prophet of Stamford" or that President Barack Obama was monitoring her. However, another mental disorder — postpartum psychosis, characterized by delirious thoughts, inability to function and frequent hallucinations — can result in maternal suicide and infanticide. Fortunately, it has low prevalence of about 1 or 2 per 1,000 deliveries.

Ms. Carey's sister reported that she had been diagnosed with postpartum depression with psychosis, underwent treatment, and was reducing her medication intake under a doctor's supervision. Ms. Carey's 54-year-old boyfriend had called the Connecticut police twice in 2012 to report her delusional behavior that endangered the life of their daughter. Additionally, discharge papers from a 2012 mental health evaluation listed two psychiatric drugs that Ms. Carey was taking: Risperidone, an antipsychotic usually used in the treatment of schizophrenia and bipolar disorders, and Escitalopram, an antidepressant. Patients with postpartum psychosis are usually treated with a combination of antipsychotics and antidepressants.

Ms. Carey's specific mental disorder has not been confirmed. While postpartum depression can begin any time during the first six months after delivery, postpartum psychosis often appears within the first two weeks. However, if not adequately treated, both disorders may last beyond the first postpartum year. The bottom line is that both mental disorders have negative consequences on families and society and that little baby Erica will spend the rest of her life without her mother.

We should be asking, what are we doing to prevent and treat mental health disorders among new mothers? The Affordable Care Act (aka Obamacare) includes a provision that calls on the secretary of Health and Human Services to expand research into the causes and treatment of postpartum depression and postpartum psychosis, and to support information and education programs to increase awareness of these disorders. Another provision encourages the secretary to fund projects that establish cost-efficient systems that deliver effective and comprehensive services to persons with or at risk for these postpartum disorders, and to address the needs of their families. Also, under the Affordable Care Act the state-based insurance exchanges are offering different tiers of benefit packages, all of which must have a base level package that includes mental health coverage.

The current government shutdown, amid which the Capitol tragedy occurred, was caused by some members of Congress refusing to pass a new spending bill unless it defunds, derails or chips away at Obamacare. Perhaps the media conversation should focus on this paradox instead of speculations on what mental disorder Miriam Carey suffered from.

Rada K. Dagher is an assistant professor in the department of Health Services Administration at the University of Maryland School of Public Health in College Park. Her email is rdagher1@umd.edu.